Healthcare Provider Details

I. General information

NPI: 1609816347
Provider Name (Legal Business Name): PATRICK THOMPSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEALTH PARK BLVD STE 1
SAINT AUGUSTINE FL
32086-5798
US

IV. Provider business mailing address

PO BOX 3266
ST AUGUSTINE FL
32085-3266
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-1010
  • Fax: 904-819-1040
Mailing address:
  • Phone: 904-518-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102388
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9102388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: